Biomedical subjects
Publications and source records attributed to J Mouiel.
Hydatid cyst of the pancreas is a rare localization of hydatidosis. It raises diagnostic problems which can only be solved by section of the surgical specimen. An exceptional case of hydatid cyst of the pancreatic tail which resulted in chronic recurrent pancreatitis, and a review of the literature, enable to put hydatidosis on the list of causes of pancreatitis.
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A randomized, double-blind comparative trial of cefoxitine and piperacillin was conducted in two groups of 30 patients with a similar number of the usual risk factors. Doses of cefoxitine 2 g and piperacillin 4 g were administered only once, except in some cases when the operation lasted more than 5 hours. Analysis of the results showed that the two antibiotics had equivalent prophylactic effectiveness (congruent to 6%) in colorectal surgery.
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Irregular fatty infiltration of the liver is an entity that may be confused with liver metastasis. Since ultrasonography and computed tomography of the liver are frequently performed, it seems to be a relatively commonly encountered lesion. The features of this syndrome are described herein in six patients in whom a liver biopsy confirmed diagnosis. Clinical and biological findings were non-specific. In 3 cases ultrasound examination of the liver showed increased echogenic areas. In 3 cases of large lesions, the remaining normal liver was seen as areas of decreased echogenicity and the fatty infiltration was considered falsely normal. The scanographic features of this entity were much more typical than those seen on ultrasonography. With CT, irregular fatty liver usually has a distinctive appearance characterized by a non-spherical shape, absence of mass effect and a density close to water (3 cases). When the fatty lesions are focal (3 cases) and less characteristic on CT, liver biopsy should be performed to confirm the diagnosis. Repeated CT examinations can demonstrate partial or total resolution of the lesions when conditions known to be associated with fatty liver have been treated.
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In the authors' experience gallstones, particularly when minute, constitute the most frequent cause of acute pancreatitis. The size of the calculi (about one millimeter) explains the two major characteristics of microlithiasis: it is "illegible" and therefore difficult to detect and frequently undiagnosed; it is "migratory", like urinary lithiasis, and may be responsible for transient hyperpressure in the pancreatic ducts resulting in acute pancreatitis. In all cases of acute pancreatitis, the possibility of biliary microlithiasis should be thoroughly investigated and relapses should be prevented by cholecystectomy with clearing of the biliary ducts under radiosurgical and/or endoscopic control.
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Splenectomy may be difficult when the spleen is deep-seated, with a short and wide pedicle, or when it is associated with portal hypertension and immobilized by epiploic or peritoneal adhesions. In such cases the conventional technique of splenectomy, even with initial ligature of the splenic artery along the superior border of the pancreas, may be insufficient to prevent hazardous bleeding. Mobilisation of the pancreatic tail in the posterior mesogastrium is recommended, as it gives access to the splenic vessels in the hilum, where they can be isolated and ligated prior to splenectomy.
The authors present a case of torsion of an intra-abdominal choriocarcinoma of the testis, in which the pre-operative diagnosis was made by aortic arteriography. The association of the two remains rare, as a review of literature proved. The orchidopexy if it does not tend to prevent the possibility of malignant change gives an easier follow-up and an earlier diagnosis.
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